title: Alternative lipid emulsions in the critically ill: a systematic review of the evidence.
abstract: OBJECTIVE
  Parenteral lipid emulsions (LEs) are commonly rich in long-chain triglycerides derived from soybean oil (SO). SO-containing emulsions may promote systemic inflammation and therefore may adversely affect clinical outcomes. We hypothesized that alternative oil-based LEs (SO-sparing strategies) may improve clinical outcomes in critically ill adult patients compared to products containing SO emulsion only. The purpose of this systematic review was to evaluate the effect of parenteral SO-sparing strategies on clinical outcomes in intensive care unit (ICU) patients.
  
  
  METHODS
  We searched computerized databases from 1980 to 2013. We included randomized controlled trials (RCTs) conducted in critically ill adult patients that evaluated SO-sparing strategies versus SO-based LEs in the context of parenteral nutrition.
  
  
  RESULTS
  A total of 12 RCTs met the inclusion criteria. When the results of these RCTs were statistically aggregated, SO-sparing strategies were associated with clinically important reductions in mortality (risk ratio, RR 0.83; 95 % confidence intervals, CI 0.62, 1.11; P = 0.20), in duration of ventilation (weighted mean difference, WMD -2.57; 95 % CI -5.51, 0.37; P = 0.09), and in ICU length of stay (LOS) (WMD -2.31; 95 % CI -5.28, 0.66; P = 0.13) but none of these differences were statistically significant. SO-sparing strategies had no effect on infectious complications (RR 1.13; 95 % CI 0.87, 1.46; P = 0.35).
  
  
  CONCLUSIONS
  Alternative oil-based LEs may be associated with clinically important reductions in mortality, duration of ventilation, and ICU LOS but lack of statistical precision precludes any clinical recommendations at this time. Further research is warranted to confirm these potential positive treatment effects.
authors.affiliation: Department of Critical Care Medicine, Faculty of Medicine, Universidad de la República (UDELAR), Montevideo, Uruguay, wmanzanares@adinet.com.uy.
authors.forename: William
authors.initials: W
authors.lastname: Manzanares
authors.forename: Rupinder
authors.initials: R
authors.lastname: Dhaliwal
authors.forename: Brian
authors.initials: B
authors.lastname: Jurewitsch
authors.forename: Renee D
authors.initials: RD
authors.lastname: Stapleton
authors.forename: Khursheed N
authors.initials: KN
authors.lastname: Jeejeebhoy
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
mesh_terms: D000328:Adult; D016638:Critical Illness / Q000628:therapy*; D016206:Databases, Bibliographic; D004655:Emulsions / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005217:Fat Emulsions, Intravenous / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D005395:Fish Oils / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007107:Immune System / Q000187:drug effects* / Q000502:physiology; D007249:Inflammation / Q000209:etiology / Q000517:prevention & control; D007362:Intensive Care Units; D054709:Lecithins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018384:Oxidative Stress / Q000187:drug effects* / Q000502:physiology; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000379:methods*; D010743:Phospholipids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010938:Plant Oils / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012450:Safflower Oil / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D013024:Soybean Oil / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome; D014280:Triglycerides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D004655:Emulsions; D005217:Fat Emulsions, Intravenous; D005395:Fish Oils; D054709:Lecithins; D010743:Phospholipids; D010938:Plant Oils; D014280:Triglycerides; C047652:safflower oil, lecithin emulsion; C545823:soybean oil, phospholipid emulsion; D013024:Soybean Oil; D012450:Safflower Oil